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Evaluating the Effectiveness of SGLT2i or GLP1RA vs. Sulfonylurea Initiation After Hospital Admission for Congestive Heart Failure and Type II Diabetes Mellitus: A Scoping Review
Full text linkPurpose/Background
The need for effective pharmacological management in patients with congestive heart failure (CHF) and type II diabetes mellitus (T2DM) is an ever-growing task for healthcare providers, especially in the primary care setting. Patients with multiple comorbidities are less likely to adhere to required rigorous medication schedules and lifestyle modifications, resulting in accelerated disease progression and defeated efforts of healthcare providers. Traditionally, sulfonylureas have been the medication management of choice by healthcare providers due to their affordability compared to modern medication. Current guidelines recommend that individuals with poor glycemic control could benefit significantly from using older sulfonylureas with other antidiabetic medications, although the non-sulfonylureas are the safer option. This scoping review examines the benefits of initiating either a sodium-glucose co-transporter 2-inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP1RA) versus a sulfonylurea in reducing hospital readmissions within 30 days of discharge in adults hospitalized with T2DM and CHF.
Methods
A literature review was conducted from August 2021 to November 2023 through PubMed, CINAHL, Medline, and Ovid databases with 81 articles containing our keywords. The authors reviewed the abstracts and found 18 eligible articles meeting the inclusion criteria for the review. Inclusion criteria included peer-reviewed, free access, full-text availability, English language, and publication within the past five years. A rapid critical appraisal tool was used to determine the validity and reliability of eligible articles. Ten articles were selected based on quality and relevance. An evaluation table evaluated the efficacy and outcomes of initiating sulfonylurea medications versus SGLT2i or GLP1RA medications in adults with T2DM and CHF.
Results
The articles in the review consisted of five systematic reviews, three randomized controlled trials, and two cohort studies. Eight articles found a decrease in heart failure hospitalizations, decreased risk for cardiovascular outcomes, and decreased all-cause mortality with the initiation of SGLT2i. With sulfonylureas, five articles showed a neutral impact on heart failure hospitalizations, one article found an increase in heart failure hospitalizations, two articles showed a neutral effect on cardiovascular outcomes, and three studies found an increased risk in cardiovascular outcomes. GLP1RAs decreased the risk for cardiovascular outcomes and all-cause mortality in four articles with reduced heart failure hospitalizations compared to sulfonylureas but a neutral impact on hospitalizations compared to SGLT2i. We could not find a single study that directly compared the efficacy of SGLT2i or GLP1RA to sulfonylureas as monotherapies in reducing 30-day hospital readmissions
Providers as Patients: The Healthcare Provider Experience of Infertility in Tennessee
Full text linkWhile the effect of age and stress on fertility is widely known, those wishing to conceive children after career attainment or lengthy training programs are not adequately prepared with the knowledge or tools to mitigate the effects of these factors. Physicians and nurses, though trained to provide healthcare to others, are not immune to this struggle. In part due to the high prevalence of infertility in the United States (US), the lack of uniform policies to support this population, and the higher rates of infertility experienced by those in the healthcare field when compared to the general population, research focused on physicians and nurses is essential.
Given the high costs of treatment for infertility, as well as the increases in demand for assisted reproductive technologies (ART), such as in vitro fertilization (IVF), egg freezing, and fertility medications, the identification of appropriate support mechanisms that can reduce the burden of the disease is critical. Using a qualitative descriptive approach, this study examined the experiences of physicians and nurses affected by infertility in the state of Tennessee (TN). Semi-structured interviews and a demographic survey were used to generate thick, deep descriptions of the phenomenon, as well as to pinpoint stressors, actionable factors influencing the satisfaction of physicians and nurses seeking infertility care, and participant-proposed support resources. Data analysis from 30 individual interviews of physicians (n=13) and nurses (n=17) revealed three sub-themes for physicians: (1) physicians and the role of knowledge, (2) physician modes of communication, and (3) physicians and the function of externalities, two sub-themes for nurses: (1) nurses and interpersonal factors, and (2) external motivators for nurses, and three sub-themes shared between the two groups: (1) physicians, nurses, and individual identity, and (2) partnerships and marriages, which were then compressed into three overarching themes, (1) understanding, (2) relationships, and (3) support.
Overall, this research aims to fill an essential gap in understanding what stressors are experienced as a result of infertility, how they uniquely affect physicians and nurses working in TN, and what policy changes can be made to better support physicians and nurses with infertility. This study is one of the first to explore the lived experiences of physicians and nurses in TN affected by infertility. Additional work is needed to capture the experiences of healthcare providers with infertility working across the US and to examine the effects of adopting policies and programs to support those with infertility
Nursing Without Boundaries: Creating the Opportunity for Wellbecoming through Dialogue Guided by Health as Expanding Consciousness
No full textThe inaugural Dr. Margaret A. Newman Distinguished Visiting Professorship lecture on Aug. 6, 2024, drew 228 nurses and nursing students to the FedEx Event Center to hear about the impact of nursing theory on nursing practice. Associate Professor Jane Flanagan, PhD, RN, AHN-BC, ANP-BC, FAAN, was the keynote speaker. Dr. Flanagan is a department chair at the Connell School of Nursing at Boston College and editor of the International Journal of Nursing Knowledge
The Role of MicroRNA-152 in the Pathogenesis of Diabetic Cardiomyopathy
No full textDiabetes mellitus, one of the world’s fast-growing diseases, is characterized by high death rates from cardiac complications named diabetic cardiomyopathy (DCM). DCM is a heart disease that occurs in both type 1 and 2 diabetes mellitus patients. Many management options have been explored in the management of DCM, including ACE inhibitors, beta-blockers, etc.; however, limited success has been recorded from these. MicroRNAs, recently discovered gene regulators, have been reported to be associated with various physiology and pathological processes in the mammalian body. These include cell proliferation, cell death, senesis, carcinogenesis, diabetes, and heart failure, among others. Various miRs have been associated with heart disease, including heart failure; however, the impact of miRs in diabetes cardiomyopathy is unknown. Here, the microRNA microarray profile of diabetic mouse hearts revealed 15 overexpressed and 3 downregulated miR, of which miR-152 had the most significant fold change compared with the control. MiR-152 was also upregulated in the human diabetic heart by greater than 2-fold. Ad. miR-152 was constructed and transfected at MOI 5-10 into neonatal cardiomyocytes to overexpress miR-152 and assess its effect on cardiac myocytes and the pathogenesis of DCM. Bioinformatics and a proteomic approach were also used to identify miR-152 target genes. MiR-152 OE was seen to induce cardiac hypertrophy and increase protein synthesis in NCM. Calcium regulation, cardiac contractility, Glucose transport and metabolism, insulin signalling, and fatty acid oxidation pathway-associated genes were identified by bioinformatics and proteomics to be targeted by miR-152. Subsequently, results show SERCA2a, contractile function, AMPK expression and phosphorylation, ACC phosphorylation, glucose uptake, and AKT phosphorylation were significantly reduced in miR-overexpressed cardiomyocytes with or without insulin stimulation when compared to control, indicating dysfunction in calcium homeostasis, contractility, fatty acid oxidation, insulin signalling and glucose metabolism. These data confirm the involvement of miR-152 in the pathogenesis of diabetic cardiomyopathy, unraveling a novel therapeutic pathway in the management of DCM. To establish these pathways, miR-152 inhibition must be explored in vivo in animal models of DCM and human volunteers
The Role of Skeletal Muscle AMPK/mTORC1 Signaling in Disrupted Metabolism during Chemotherapy Treatment and Recovery
Full text linkColorectal cancer patient survival rate has increased over the past decade due to improved screening and treatment options. The clinically relevant FOLFOX (5-fluorouracil [5-FU], oxaliplatin, leucovorin) chemotherapy regimen is a mainstay treatment option, despite the development of severe side-effects that can occur acutely or develop as a late effect after treatment cessation. Cancer and chemotherapy can promote systemic metabolic dysfunction; consequently, patients will likely experience debilitating weakness and fatigue, and these symptoms are often accompanied by excessive fat and muscle loss. Although studies have established chemotherapy effects on the tumor, few have investigated mechanisms underlying the metabolic complications associated with cancer and chemotherapy that may persist long after treatment completion. Using in vitro and in vivo approaches, the overall purpose of this study was to determine the role of AMPK/mTORC1 signaling in cancer and FOLFOX chemotherapy- induced metabolic dysfunction. Specifically, the AMPK/mTORC1 regulation of autophagy and protein synthesis was examined acutely after treatment, during recovery with and without exercise, and in combination with the inflammatory tumor environment in male and female mice. The hypothesis was that FOLFOX chemotherapy will suppress muscle protein synthesis and autophagy through altered AMPK/mTORC1 signaling, and these disruptions will not be readily reversible following treatment completion; AMPK activation will offset these aberrations in vitro. The results from the study reveal that FOLFOX chemotherapy induced long-lasting functional deficits that were prevented by long- (60min/d) and short-duration (15min/d) treadmill exercise training performed over two weeks during recovery from FOLFOX. Whole-body metabolic rate was suppressed in male FOLFOX treated mice up to 10-weeks after treatment cessation. These metabolic aberrations were independent of changes in cage activity and food intake. In vitro we present novel evidence that FOLFOX exerts direct effects to suppress AMPK/mTORC1 signaling, protein synthesis, and autophagy flux. AMPK activation with metformin was not sufficient to regulate autophagy flux, however, rapamycin treatment partially restored the FOLFOX-suppression of autophagy flux in myotubes. Finally, we present evidence that FOLFOX and the C26-tumor environment exert distinct effects on inflammatory and metabolic signaling. FOLFOX attenuated the C26-induction of plasma IL-6 and LIF in males but not females. FOLFOX and female sex altered the relationship between circulating cytokines to tumor and lean mass. FOLFOX suppressed muscle AMPK phosphorylation only in male muscle and this was independent of the tumor. Future studies should examine the sex hormone regulation of inflammation and metabolism during chemotherapy treatment and recovery in clinically relevant tumor models. Overall, we demonstrate effects for FOLFOX to induce persistent metabolic dysfunction that can be mitigated by a low dose of exercise and provide rationale for investigation into the therapeutic potential of rapamycin to offset chemotherapy toxicities
Biological Evaluation of Anti-Cancer Activities of Novel Small-Molecule Tubulin Polymerization Inhibitors in Prostate and Pancreatic Cancer
Full text linkColchicine binding site inhibitors (CBSIs) are an emerging class of microtubule-targeting agents (MTAs) with promising potential for cancer therapy. Traditional MTAs like paclitaxel, docetaxel, and Cabazitaxel, are three FDA-approved taxanes for treating various cancers. Acquired chemoresistance and toxicities caused by chemotherapy are some of the main barriers that limit their clinical outcomes. More effective novel agents and therapeutic strategies are needed to overcome these challenges. Tremendous efforts have been made in discovering novel CBSIs and evaluating many cancer types, reporting their promising potential to treat both primary, resistant, and metastatic cancers including breast cancer, ovarian cancer, lung cancer, and melanoma. However, no CBSIs have received FDA approval to date, and limited effective discoveries have been made in advanced malignancies such as castration-resistant prostate cancer and pancreatic cancer, underscoring the need for further research in this area of drug discovery and development. This dissertation focuses on evaluating the anti-cancer efficacy of novel CBSIs developed in-house for the treatment of castration-resistant prostate cancer and pancreatic ductal adenocarcinoma. Chapter 1 outlines the rationale behind this study, emphasizing the significance of CBSIs and presenting the central hypotheses. Chapter 2 provides a detailed account of the experimental models, materials, and methodologies. Chapter 3 presents the preclinical evaluation results of the novel compound SB-216, focusing on its therapeutic potential in both in vitro and in vivo models of prostate and pancreatic cancers. Lastly, Chapter 4 discusses the broader implications of the findings and explores potential avenues for future research
Pharmacologic Management of Postpartum Hemorrhage in an Urban Hospital
Full text linkThis retrospective chart review examined female patients (N=25) who had a postpartum hemorrhage. Electronic medical records from Regional One Health were queried for ICD-10 072 related codes from January 1, 2021-October 31, 2023. Of those, a maximum of 25 charts were identified and the information was deidentified. All data was de-identified, coded, encrypted, housed, and locked securely. Selected records that met the above criteria were then queried for the following: Baseline demographics, gravida, para, amount of blood loss, pharmacological and non-pharmacological interventions, and timing of tranexamic acid (TXA) administration. Data was imported into MS Excel and statistical analysis was conducted using Intellectus Statistical Software. Continuous variables were reported as mean, median, and categorical variables as frequency (%)
The Impact of Social Determinants of Health on Adherence to Urinary Tract Infection Treatment: A Scoping Review
Full text linkPurpose/Background
Urinary tract infections (UTIs) are a common diagnosis among children. Patients must fully comply with treatment regimens to reduce the risk of recurring UTIs and prevent long-term complications. This scoping review aims to evaluate the literature and examine the association between screening for social determinants of health (SDH) and adherence to UTI treatment.
Methods
A thorough literature search via PubMed, Cochrane Library, Elsevier Clinical Key, CINAHL, and JAMA was conducted with the following keywords: Pediatric UTI, Adherence to Treatment Plans, Social Determinants of Health, Social Needs Screening, and others. Ten articles were appraised for their evidence and quality. The articles focus on the diagnosis of a UTI in the pediatric population, social needs screening, SDH, and treatment compliance. A synthesis of results table was composed to examine SDH and evaluate the association between social needs screening and improved outcomes.
Results
The literature review indicates a correlation between unmet social needs and patient outcomes. UTIs can affect patients and their families, and in-person interventions can improve compliance and health outcomes. Two studies reported improved health outcomes following social needs screening and allocation of resources. Two studies highlight the importance of the medical home and provider\u27s role in assisting with social needs.
Implications for Practice
The results of this scoping review highlight the need for social needs screening and provide insight into the effects that unmet social needs can have on treatment compliance. Providers can strive to improve patient outcomes by screening for social needs and allocating resources. This review highlights the need for further research into implementing social needs screening in clinical practice to reduce UTIs and improve compliance in the pediatric population
Using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to Decrease Length of Stay: A Scoping Review
Full text linkPurpose/Background
Delirium is a prevalent challenge among ICU patients, impacting approximately 30% of admissions (Brennan et al., 2023). If left untreated, delirium can increase use of restraints, hospital length of stay, intensive care unit length of stay, and ultimately, morbidity and mortality. This scoping review assesses the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to gauge its efficacy in reducing the length of stay in the ICU for adult patients with delirium.
Methods
A literature review from 2018 and 2023, using PubMed, CINAHL, and Medline were utilized for the search along with key words such as: length of stay, confusion assessment method (CAM), intensive care unit, and delirium bundle. Ten articles consisting of meta-analyses, systematic reviews, controlled trials, and observational studies met our inclusion criteria. The focus was on CAM-ICU\u27s role in identifying delirium and its impact on the ICU length of stay.
Results
CAM-ICU, with 94% sensitivity and 89% specificity, emerged as an effective tool for delirium identification in the ICU setting (Mailhot et al., 2022). The selected articles revealed diverse outcomes regarding ICU length of stay. Three studies reported a decrease, while five indicated an increase in ICU stays when delirium was present. Importantly, CAM-ICU consistently operated within comprehensive delirium bundles challenging assumptions that CAM alone decreases length of stay without other interventions in the bundles.
Implications for Nursing
The findings underscore the effectiveness of CAM-ICU for delirium identification. With its high sensitivity, CAM-ICU proves valuable in early detection of delirium. However, the varied impact on ICU length of stay emphasizes the necessity for nursing involvement in the execution of CAM-ICU assessments within the broader framework of delirium management. Ultimately, nurses can play a pivotal role in contributing to enhanced patient outcomes by utilizing CAM-ICU as part of comprehensive delirium interventions in the ICU
Pharmacological Interventions Alone Versus Lifestyle Modifications for Reduction in Atrial Fibrillation
Full text linkPurpose/Background
Atrial fibrillation is considered the most common arrythmia affecting individuals globally with an estimated occurrence of 12.1 million individuals by 2030 in the US alone (Joglar et al., 2023). Recent evidence suggests lifestyle modification in combination with pharmacological therapy may decrease the overall financial and health burdens associated with atrial fibrillation (Elliot et al., 2023). The aim of this scoping review is to examine the existing literature to evaluate prescription only versus prescription and lifestyle modifications and its effect of reducing negative health outcomes and overall burden of atrial fibrillation diagnoses.
Methods
Ten articles from 2014 through 2024 were evaluated by research methods that adequately align with this scoping review and include appropriate subsets of data. Reviewing articles that compare the pharmacological versus non-pharmacological management of patients with atrial fibrillation. Including, evaluation using rapid critical appraisal and creation of overall synthesis tables to provide evidence supporting the results.
Results
Overall, the effectiveness of pharmacological and lifestyle changes was superior to reduce the burden of atrial fibrillation via reduction of thrombotic events, rate and rhythm control, and exacerbations requiring hospitalizations.
Implications for Nursing Practice
First-line treatment for patients diagnosed with atrial fibrillation is medication management. Comorbidities are often not addressed as factors in this diagnosis. Atrial fibrillation expected to affect 12.1 million people globally by 2030 (Joglar et al., 2023). Uncontrolled atrial fibrillation leads to increased burdens on the patient’s health and financial system and has a significant negative impact on health and quality of life. Therefore, lifestyle modifications incorporated into treatment regimens improve overall outcomes